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Methods compare 28 patients requiring perfusion-based plan changes with 274 without changes after laparoscopic low anterior resection, analyzing demographics, anastomotic height, and 6-month LARS scores. Results show higher anastomoses and improved bowel function in the change group. Conclusions support ICG-based personalization to improve functional 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\n[https://doi.org/10.1007/s00384-025-05065-8](https://doi.org/10.1007/s00384-025-05065-8)  \nDeep impact analysis of surgical strategy changes guided by indocyanine green fluorescence angiography in laparoscopic low anterior resection for rectal cancer  \nXuan Qiu1,2 · Victor A. Kashchenko1,3 · Anatoly A. Zavrazhnov3 · Timur S. Lankov3 · Litian Ye1 · Valery V. Strizheletsky1 · Georgy A. Smirnov1  \nReceived: 29 October 2025 / Accepted: 12 December 2025 © The Author(s) 2026  \nAbstract  \nPurpose This study investigated the patient factors leading to ICG fluorescence angiography (ICG–FI)–guided surgical plan changes during rectal cancer surgery and evaluated the impact of these changes on anastomotic height and postoperative bowel function.  \nMethods In a retrospective analysis of 302 patients undergoing laparoscopic low anterior resection, we compared 28 patients requiring perfusion-based plan changes (Change group) to 274 without changes (No-Change group) . We analyzed demographics, anastomotic height, and 6-month LARS scores.  \nResults The Change group had significantly older age, higher BMI, more neoadjuvant therapy, and lower tumor height. Their final anastomoses were higher (8.0 vs. 6.0 cm, p \u003C 0.001). This group also had better bowel function, with lower LARS scores (18 vs. 25, p = 0.007) and fewer major LARS cases (14.3% vs. 32.1%, p = 0.041) . Anastomotic leakage rates were similar. Conclusions ICG–FI identifies patients with perfusion risk factors (age, obesity, neoadjuvant therapy, low tumors) who benefit from surgical plan modification. Guiding the proximal resection margin based on ICG assessment to create a higher, well-perfused anastomosis significantly improves functional outcomes, underscoring its role in personalized surgery.  \nTrial registration The study was registered in the clinical trials registry with registration number NCT06270745 .  \nKeywords Indocyanine green · Surgical plan modification · Anastomotic height · Low anterior resection syndrome · Rectal cancer · Laparoscopic surgery  \nIntroduction  \nColorectal cancer (CRC) remains a leading cause of cancerrelated morbidity and mortality worldwide. For rectal cancer, low anterior resection (LAR) is the cornerstone procedure to preserve sphincter function without compromising oncologic outcomes [1–3] . However, anastomotic leakage (AL) represents a devastating complication, with suboptimal  \n* Xuan Qiu[qiuxuan100@163.com](qiuxuan100@163.com)  \n1 Department of Faculty Surgery, St. Petersburg State University, Saint Petersburg 199106, Russian Federation  \n2 Department of General Surgery, Shandong Linglong Yingcheng Hospital, Zhaoyuan, Shandong, China  \n3 Beloostrov High Technology Clinic (MMC VT LLC), Leningrad Region 188652, Russian Federation  \nvascular perfusion being a key determinant. Intraoperative indocyanine green fluorescence angiography (ICG–FI) provides real-time, objective perfusion assessment, which prompts surgeons to modify the surgical plan in approximately 9–10% of cases—a figure supported by meta-analyses reporting a weighted mean change rate of 9.6%(95% CI 7.3–11. 8%) [2–6] .  \nWhile prior studies have demonstrated that ICG–FI significantly reduces the overall AL rate, the specific cohort of patients in whom perfusion assessment necessitates a change in the proximal resection margin remains underexplored [5, 7] . This specific intervention, by altering the anastomotic height, may critically influence postoperative bowel function, which is quantitatively measured by the low anterior resection syndrome (LARS) score—a validated instrument for assessing incontinence, urgency, and overall quality of life [8] .  \nTherefore, this study innovatively adopts a “change versus no-change” perspective within a uniformly ICG–FI–managed cohort. We aim to elucidate the distinctive patient characteristics associated with inadequate perfusion and to determine the subsequent impact of surgical plan modifica","cbCaikZwNEBwDOWT","https://ap.wps.com/l/cbCaikZwNEBwDOWT","pdf",741907,"English","# Abstract\n# Introduction\n# Materials and methods\n## Study design and patients\n## ICG–FI protocol\n## Follow‑up","[{\"question\":\"What was the main purpose of the study?\",\"answer\":\"To identify patient factors that trigger ICG fluorescence angiography–guided changes in the surgical plan during rectal cancer surgery and to evaluate how those changes affect anastomotic height and postoperative bowel function.\"},{\"question\":\"How were patients grouped in the analysis?\",\"answer\":\"Patients (n=302) undergoing laparoscopic low anterior resection were categorized into a Change group when perfusion assessment indicated inadequate perfusion (e.g., perfusion time \\u003e 60 s or no fluorescence) and a No-Change group when perfusion was adequate.\"},{\"question\":\"What differences were found between the Change and No-Change groups?\",\"answer\":\"The Change group had higher final anastomotic height and better bowel function, reflected by lower LARS scores and fewer major LARS cases, while anastomotic leakage rates were similar.\"}]","Deep impact analysis of surgical strategy changes guided by indocyanine green fluorescence angiography in laparoscopic low anterior resection for rectal cancer | PDF",1790651007,23]